MEDICARE: MICHELLE VENEKLASEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		SD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		SD
3	101YM0800X	Mental Health Counselor	LPCMH2285	SD
4	101YP2500X	Professional Counselor		SD

General Provider Information

NPI Number	:	1790154094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE VENEKLASEN

Provider Business Mailing Address
First Line	:	2640 JACKSON BLVD STE 6
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3400
Country	:	US
Telephone Number	:	605-341-8947
Fax Number	:	605-341-0489

Provider Business Practice Location Address
First Line	:	2640 JACKSON BLVD STE 6
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3400
Country	:	US
Telephone Number	:	605-341-8647
Fax Number	:	605-341-0489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	10/09/2025

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Directions to “ MICHELLE VENEKLASEN ” Practice Location

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